When is shoulder replacement recommended?
Shoulder replacement surgery is recommended for patients who are experiencing:
- Severe shoulder pain that limits daily activities like movement and lifting
- Moderate to severe pain even while resting
- Loss of motion or weakness in the shoulder
- Failure to improve with other treatments like medications and physical therapy
Although most patients who undergo shoulder replacement surgery are aged between 60 to 80, there is no absolute age restriction for this procedure. The surgeon will evaluate several considerations before deciding whether a shoulder replacement is suitable for you.
The considerations include:
- Medical history – your orthopaedic surgeon will gather information about your general health and ask questions related to your knee pain.
- Physical examination – your orthopaedic surgeon will access your shoulder mobility, and the strength of the surrounding muscles, the rotator cuff.
- X-rays – imaging helps your orthopaedic surgeon determine the extent of damage in your shoulder, and the type of shoulder arthritis you have.
- MRI – an MRI scan may be needed to determine the condition of your cartilage and bone and the extent of damage to your rotator cuff
A shoulder replacement consists of two important steps – choosing the right implant components and the actual procedure.
There are a few types of shoulder replacement options available and the one you will need depends on your condition:
- Total shoulder replacement – involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem and plastic socket.
- Reverse total shoulder replacement – the positions of the socket and metal ball are switched, improving the mechanical advantage of the deltoid muscle, allowing it to lift the arm, independent of the torn rotator cuff. This is most suitable for shoulder arthritis where the rotator cuff is torn beyond repair.
- Stemmed hemiarthroplasty – the head of the humerus is replaced with a metal ball and stem, while retaining the native glenoid. This is commonly used for those with severe humeral fractures, which are not suitable for fixation, but the socket is healthy.
- Resurfacing hemiarthroplasty – involves replacing the joint surface of the humeral head with a cap-like prosthesis without a stem with the benefit of preserving bone
Your orthopaedic surgeon will discuss with you regarding the most suitable type of implant to use to give you the best outcome.
Your orthopaedic surgeon will replace your shoulder joint with the chosen artificial device during the surgery.
Your orthopaedic surgeon will make an incision over your shoulder and use special guiding instruments to remove the damaged bone and cartilage. The components can then be “pressed” into bony to allow your bone to grow into the components or cemented into place. This decision will depend on the quality and strength of your bone.
Advances in shoulder replacement technology have resulted in increased longevity of shoulder replacements, allowing patients to greatly improve their quality of life. These include improved surgical techniques for accurate positioning of the shoulder components, such as patient specific instrumentation, and improved bearing surfaces and designs that improve the stability and range of motion of the replaced shoulder.
Commonly Asked Questions
Planning for the surgery
Your orthopaedic surgeon may recommend consulting your primary doctor or anaesthetist to check your general medical condition and do blood tests, a chest X-ray, and an electrocardiogram to assess your fitness for surgery.
You will most likely be admitted to the hospital for one to three days after a shoulder replacement surgery.
Consult your orthopaedic surgeon for specific instructions but you may have to stop taking traditional medicine, blood thinning medications and control your general medical conditions before the surgery. You may also need help with daily activities like bathing and cooking so it would be best to get these arrangements sorted out before the operation.
A shoulder replacement is commonly performed under general anaesthesia (put to sleep), which may be supplemented with nerve blocks or injections of local anaesthetic to reduce pain. Your orthopaedic surgeon and anaesthetist will discuss the best method with you.
A shoulder replacement surgery typically takes around two hours.
As with all surgeries, a shoulder replacement procedure comes with a low risk of complications such as infection, fractures, nerve and vessel injury, and implant problems. However, when complications occur, most are successfully treatable.
Feeling some pain is part and parcel of the healing process after surgery. Rest assured that your doctor will prescribe medications for short-term pain relief.
Paracetamol, non-steroidal anti-inflammatory drugs, and opioids are common temporary pain relief medications that will be prescribed.
Your arm will be put in a sling to support and protect your shoulder. You may start with gentle physical therapy after the surgery to strengthen your shoulder and improve flexibility. It is important to keep wounds clean and dry to reduce the risk of infection. You should have a balanced diet to promote proper tissue healing and restore muscle strength.
Take special precautions to avoid lifting heavy objects for the first six weeks after surgery. It is also beneficial for you to follow the home exercises recommended, two to three times a day for at least 3 months. Do not participate in contact sports or do repetitive heavy lifting after your shoulder replacement to ensure it lasts as long as possible without giving you any problems.